Catia Cilloniz

Older adults with chronic obstructive pulmonary disease (COPD) are particularly vulnerable to respiratory infections because of reduced pulmonary reserve, comorbidity, and age-related changes in immune function. This narrative review examines the role of vaccination in older adults with COPD, focusing on influenza, pneumococcal, respiratory syncytial virus (RSV), COVID-19, and other vaccines recommended according to age or individual risk. Influenza and pneumococcal vaccination have the longest-standing COPD-specific evidence, with studies reporting reductions in selected respiratory outcomes and COPD exacerbations. RSV vaccines have shown efficacy against RSV-associated lower respiratory tract disease in large trials of older adults, and more recent observational studies in COPD have reported protection against RSV-related hospitalization and severe exacerbations. Data on COVID-19 vaccination in COPD support immunogenicity and acceptable safety, but direct evidence for prevention of COPD exacerbations is limited. For other vaccines, recommendations are based mainly on age and individual risk, with relatively little evidence for COPD-specific clinical outcomes. Vaccination should be considered an important component of preventive care in older adults with COPD, although the evidence supporting individual vaccines differs in both quantity and direct applicability to this population. Important uncertainties remain regarding effects on all-cause exacerbations, hospitalization, mortality, functional outcomes, and the duration of protection.

To compare the clinical characteristics, management, and outcomes of community-acquired pneumonia (CAP) caused by Haemophilus influenzae in people living w

Lower respiratory infections remain the leading infectious cause of death worldwide, with pneumonia causing a substantial burden of morbidity, mortality, and long-term complications in older adults, particularly among those with chronic comorbidities, immunocompromising conditions, or those living in nursing homes. Streptococcus pneumoniae remains the leading bacterial pathogen, while influenza, SARS-CoV-2, and respiratory syncytial virus (RSV) are major viral causes of pneumonia and may predispose individuals to secondary bacterial infection. Vaccination is the cornerstone of prevention. Pneumococcal conjugate vaccines and vaccines against influenza, COVID-19, and RSV reduce clinically relevant respiratory outcomes in older adults, although the strength of evidence and the endpoints evaluated differ among vaccines. However, vaccination coverage remains suboptimal because of limited awareness, vaccine hesitancy, differences in immunization policies, and barriers to healthcare access. Improving vaccine uptake through life-course immunization strategies, strong recommendations from healthcare professionals, and equitable access could help reduce pneumonia burden among older adults.

Background: Genomic surveillance of Streptococcus pneumoniae (S. pneumoniae) is concentrated in high-income countries (HICs), yet the burden of pneumococcal disease falls disproportionately on lower-income settings. Whether pneumococcal population structure and resistance gene prevalence are segregated by national income, with implications for empirical therapy and vaccine policy, remains poorly defined, and of ongoing importance. Methods: We analysed 4,328 S. pneumoniae genomes from 21 countries (2018–2024), processed de novo from raw reads through a single unified pipeline. Genomes were stratified by World Bank income group and compared between HIC and non-HIC settings for serotype, lineage, acquired resistance gene prevalence, predicted phenotypic susceptibility, and estimated vaccine-serotype coverage. A 79-isolate Colombian cohort with real phenotypic antimicrobial susceptibility testing (CLSI M100, 34th edition) provided in silico validation. Findings: Population structure diverged markedly by income classification. HICs were dominated by serotype 3 and the persistent ST180/GPSC12 lineage, whereas non-HICs were dominated by serotype 19F and a more dynamic lineage composition. Acquired resistance genes were more prevalent in non-HIC settings, including tet(M) (67·3% vs 15·8%) and erm(B) (35·0% vs 13·7%); this disparity was consistent across both invasive and carriage isolates. Under meningitis breakpoints, predicted penicillin susceptibility was 74·6% in HIC versus 31·0% in non-HIC, a pattern validated by phenotypic testing in the Colombian cohort (32·91% penicillin susceptible under meningitis breakpoints). PCV13 covered a greater proportion of non-HIC isolates (47·5% vs 28·8%; p<0·001), whereas PCV21 disproportionately covered HIC isolates (79·0% vs 50·2%; p<0·001). Interpretation: Pneumococcal genotype, resistance gene burden, and vaccine-preventable fraction differ systematically by World Bank income classification. Empirical antibiotic regimens and vaccine formulations optimised using HIC data may underperform in the settings bearing the greatest pneumococcal burden, underscoring the need for income-stratified genomic surveillance and locally informed vaccine selection.

Antimicrobial resistance is a significant threat to healthcare worldwide. The appropriate use of antimicrobials could decrease the excess morbidity of respiratory infections and contribute to reducing the emergence of multidrug resistance. For this purpose, the European Union has funded the VALUE-Dx project to assess the value of rapid diagnostic tests in combatting antimicrobial resistance by optimising antibiotic use in community-acquired lower respiratory tract infections (CA-LRTI). In this context, the current statement aims to review the literature and current practice regarding the role of rapid diagnostic tests in managing CA-LRTI for antibiotic stewardship purpose and combatting antimicrobial resistance. In particular, the present paper evaluates the accuracy of rapid diagnostic tests for the aetiological diagnosis of CA-LRTI, the usefulness of biomarkers and clinical algorithms in the management of CA-LRTI, the differences in aetiology according to the diagnostic protocol and tests applied for CA-LRTI after the introduction of rapid diagnostic tests for a complete microbiological investigation and, finally, the role of rapid diagnostic tests in antibiotic stewardship protocols in improving clinical outcomes.

Since its identification in 2001, human metapneumovirus (hMPV) has been recognized as an important cause of acute respiratory tract infection in all age groups. Although infection is often mild in healthy adults, hMPV can cause severe lower respiratory tract disease, including pneumonia, in young children, older adults, individuals with chronic diseases and immunocompromising conditions, and residents of long-term care facilities. Accumulating evidence demonstrates that hMPV contributes substantially to hospitalization, intensive care unit admission, and mortality in these high-risk populations. Globally, hMPV circulates seasonally, most commonly in late winter and spring, contributing to both community- and healthcare-associated respiratory infections; however, the COVID-19 pandemic disrupted established epidemiology, resulting in shifts in epidemic timing, off-season resurgences, genotype replacement, and increased overlap with other respiratory viruses, while also providing insights into viral interference and multivirus cocirculation. Clinical manifestations of hMPV overlap with other respiratory viruses, including influenza virus or SARS-CoV-2, and selective diagnostic practices contribute to under-recognition and under-testing. Although no specific antiviral therapies or licensed vaccines are currently available, identification of hMPV has important implications for diagnostic accuracy, prognosis, antimicrobial stewardship, and infection prevention, particularly in hospital and long-term care settings. This review summarizes current evidence on the virology, epidemiology, post–COVID-19 trends, clinical manifestations, outcomes, diagnosis, and prevention of hMPV, with a particular focus on adults and other high-risk populations. We also review the current landscape of hMPV vaccine development and its potential implications for clinical practice and public health.